Cleft Lip And Palate Surgery:

The incomplete or abnormality in the formation of the upper lip /cleft lip or roof of the mouth/cleft palate can occur individually, or both defects may occur together. Cleft palate is a congenital deformity that causes a multitude of problems and represents a special challenge to the medical community. Special care is needed for patients with cleft palate. Speech production, feeding, maxillofacial growth, and dentition are just a few important developmental stages that may be affected. The conditions can vary in severity and may involve one or both sides of the face.

Multiple specialists make up the team that works together to improve the quality of life for patients with cleft palate. Otolaryngologists, oromaxillofacial surgeons, plastic surgeons, nutritionists, and speech pathologists are just a few of the members of the team. Psychological effects on both the patient and the parents are important aspects that also need to be addressed. A significant number of patients with cleft palate have associated syndromes that may result in cardiac, limb, or other system defects. Although cleft palate deformity was described hundreds of years ago, to this day, no agreed-upon management algorithm exists for patients with cleft palate. See the image below.

Craniosynostosis Surgery:

The term craniosynostosis refers to premature fusion of one or more of the 6 cranial sutures, the midline metopic and sagittal sutures, and each bilateral coronal and lambdoid suture. It usually manifests as an observable deformity within the first few months of life. Craniosynostosis can be present at birth but can be missed if mild. The premature fusion of sutures can produce intracranial hypertension, which may lead to abnormal neurocognitive development in affected children. The image below depicts unilateral coronal craniosynostosis.

Plastic Surgery:

Plastic surgery is a medical procedure with the purpose of alteration or restoring the form of the body. Though cosmetic or aesthetic surgery is the most well-known kind of plastic surgery, plastic surgery itself is not necessarily considered cosmetic; and includes many types of reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancer or tumours. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. Cosmetic surgery is an optional procedure that is performed on normal parts of the body with the only purpose of improving a person’s appearance and/or removing signs of aging. Craniofacial surgery is divided into paediatric and adult craniofacial surgery. Paediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and paediatric fractures.

Facial Reanimation:

 

Facial reanimation is the process of surgically correcting facial paralysis; congenital or acquired through trauma or disease. Facial paralysis can be a consequence of traumatic facial nerve injury, iatrogenic causes, malignancy, congenital syndromes, and viral infections. Prolonged paralysis can result in ocular complications, articulation difficulties, impaired feeding, and difficulty in conveying emotion through expressive movement. Dynamic procedures aim to restore some voluntary movement and, thus, are more desirable. Numerous reanimation techniques are available to restore function and are based on the cause of the facial paralysis, type of injury, its location, and the anticipated duration.

These methods are broadly classified into 4 types as follows: (1) neural methods, (2) musculofascial transpositions, (3) microneurovascular transfer (4) facial plastic procedures, and (5) prosthetics.

The static facial surgeries include:

• Fascia lata sling &Static sling
• A dynamic lower lip tightening& Eyelid procedures

The dynamic facial reanimation surgeries include:

• Digastric transfer
• Temporalis Muscle techniques
• Nerve repairs, transfers and grafting
• Free muscle flaps

 

Cranial Or Iliac Bone Surgery For Nasal Reconstruction:

Traditionally, reconstruction of the nasal supporting structure has been achieved with septal or auricular cartilage grafts or a combination of the two. Bone graft nasal reconstruction is advantageous, however, when significant structural support is needed or when cartilage donor sites are inadequate. The technique of bone graft nasal reconstruction has evolved over time. Cartilage: Autogenous cartilage grafts are the most frequently used material for nasal augmentation. Collagen gel matrix: Britt and Park stated that tissue-engineered cartilage can be produced reliably and that predetermination of graft shape is possible.

Perialar Rim Bone Graft:

Despite increasing specialization of craniofacial surgery, certain craniofacial techniques are widely applicable. In the top five widely applicable craniofacial procedures perialar rim bone graft is the one.

Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly.

Bone generally has the ability to regenerate completely but requires a very small fracture space or some sort of scaffold to do so. Bone grafts may be autologous (bone harvested from the patient’s own body, often from the iliac crest), allograft (cadaveric bone usually obtained from a bone bank), or synthetic (often made of hydroxyapatite or other naturally occurring and biocompatible substances) with similar mechanical properties to bone. Most bone grafts are expected to be reabsorbed and replaced as the natural bone heals over a few months’ time

 

Lateral Canthopexy Surgery:

 

The shape of the eye is determined by the relation of the upper and lower eyelids. The space between the upper and lower lids that frames the eye itself is called the palpebral fissure. In young adults with normal facial skeletons, this opening is long and narrow. Heredity, aging, paralysis, trauma and previous surgery can all impact this youthful shape. Aging eyes have a rounder shape, due to the gravitational descent, or droop, of the lower lid, and the medial migration of the lateral canthus when the outer corner of the eye, where the eyelids meet, moves inward.

Standard blepharoplasty or eyelid surgery techniques, which remove lower eyelid skin, and often muscle, tend to drop the lower lid margin, further rounding the palpebral fissure. Newer blepharoplasty techniques, including arcus marginalis release with fat transposition, have been designed to avoid this rounding effect. Two related procedures, canthopexy and canthoplasty, are used to elevate the lower lid when it has already fallen or to prevent it from falling during a lower eyelid procedure.

 

Osseous Genioplasty:

The chin is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile. A Sliding Genioplasty is a less-invasive surgical procedure designed to correct a retrusive chin and achieve a more aesthetically pleasing facial structure. Different from other forms of Chin Augmentation, the Sliding Genioplasty procedure involves making a cut through the bone of the chin, which is called an osteotomy. By freeing up the malposition bone, is able to reposition the area to an ideal orientation. A small plate, made from titanium, is used to secure the chin in its new position on the jawbone. 

 

Bone Graft Harvest For Orbital Floor Defects:

Autogenous bone grafts are the gold standard for reconstruction of maxillofacial defects. Autogenous bone becomes osseointegrated and vascularized at its site of implantation, which decreases the chances of infection, displacement, and foreign body reaction compared with alloplastic implants. The drawbacks are the harvest time, donor site morbidity, graft resorption, modeling changes, and harvest volume limitations. Autogenous bone can be harvested from multiple sites, including the calvarium, tibia, anterior ileum, posterior ileum, rib, sternoclavicle, zygoma, mandible, and so forth. The use of calvarial bone grafts (CBGs) was first reported in 1670, when Van Meekren reconstructed a Russian soldier's calvarial defect utilizing a CBG from a dog.

Fronto-Supraorbital Advancement& Fronto-Orbital Advancement Surgery:

Fronto-orbital dysmorphology in nonsyndromic bilateral coronal synostosis includes frontal flattening, supraorbital recession, and ocular globe protrusion. Surgical advancement of the supraorbital region ("bandeau") is performed to correct these deformities. bilateral coronal synostosis was performed to assess the effect of two types of bandeau fixation at the nasion. The surgical goals of FOA are threefold:

Ø  To release the synostosed suture and decompress the cranial vault,

Ø  To reshape the cranial vault and advance the frontal bone, and

Ø  To advance the retruded supraorbital bar, providing improved globe protection and an improved aesthetic appearance.

Paediatric Plastic And Craniofacial Surgery:

Paediatric cleft lip and cleft palate is congenital disorders of craniofacial complex which occur in the early part of pregnancy and are present at birth. Paediatric cleft palate occurs when the shelves of the palate fail to meet or fuse together, resulting in an opening in the roof of the mouth. Paediatric cleft lip occurs when the presence of one or two vertical fissures in the upper lip can be on one side only or on both sides resulting from failure of the normal process of lip fusion during embryonic life.

A pediatric plastic surgeon and oral maxillofacial surgeon are critical members of child's pediatric reconstructive surgery team. Their role and goal is to create a functional lip and palate that will appear as normal as possible, providing support for the lip and base of the nose area.

Craniofacial Trauma:

Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.

 

 

 

 

Craniofacial Surgery-2

(International Conference  on Craniofacial Surgery)

Scope:

• ·CMF plate and screw fixation dominated the overall product market in 2014, owing to its wide usage in increasing number of CMF trauma and reconstruction procedures which are non-elective.
• ·Metallic implants were the most widely used implants in 2014, owing to associated advantages associated such as rigid support to fracture, non-corrosive in nature and greater market penetration. In addition, increasing demand for minimally invasive surgery and the introduction of technologically advanced products for reconstructive surgery are expected to fuel market growth over the forecast period.
• ·The plastic surgery market is expected to register lucrative growth over the forecast period owing to, the increasing demand and expenditure on cosmetic surgery, especially in developed economies such as the U.S. and Canada.
• ·North America was the largest regional craniomaxillofacial devices market in 2014. The region’s market position is attributed to by factors such as introduction of technologically advanced CMF devices, rising demand for minimally invasive surgeries, presence of sophisticated healthcare infrastructure and high patient awareness levels.
• ·Asia Pacific region is anticipated to register rapid growth over the forecast period owing to, factors such as the presence of high unmet needs, increasing patient awareness levels and improving healthcare infrastructure.
• ·Key market players of the craniomaxillofacial devices include KLS Martin L.P., Boston Medical Products Inc., Johnson & Johnson (DePuy Synthes), Medtronic Inc., TMJ Concepts, Stryker Corp., Aesculap, Medartis AG, Integra LifeSciences, OsteoMed, Gore Medical, Kanghui Medical Innovation Co. Ltd., and Zimmer-Biomet Inc.
• The industry participants are adopting sustainability strategies such as the introduction of technologically advanced products in a probe to increase market penetration. For example, in January 2015, Aesculap implant systems launched ProSpace, a highly stable and oestoconductive scaffold for posterior lumbar interbody fusion procedure. 

Market Report:

Global Craniomaxillofacial Devices Market is expected to reach USD 1.71 billion by 2022, according to a new study by Grand View Research, Inc. Increasing incidence rate of facial fractures and demand for minimally invasive reconstruction surgery are expected to drive the craniomaxillofacial devices market over the forecast period. Introduction of advanced procedures such as robotic arm assisted CMF surgery and bio-absorbable implants for cranial fixation are also expected to drive the demand for craniomaxillofacial devices over the forecast period. Virtual plating technology, 3D implants and development of cost effective thoracic fixation devices are further expected to provide this market with robust future growth opportunities. Additionally, presence of favorable initiatives for instance, ASCFS  (American Society of Craniofacial Surgery) in the U.S. and ISCFS (International Society of Craniofacial Surgery)  conducting  periodic symposiums, aimed at increasing patient and surgeon awareness levels related to CMF procedures is expected to boost usage rates over the forecast period. The market is also expected to gain penetration owing to, the growing geriatric population prone to osteoporosis and increasing adoption rates of premium products such as titanium mesh for CMF surgery.